Combined EUS-Guided Abdominal Cavity Drainage and Cystogastrostomy for the Ruptured Pancreatic Pseudocyst
(a) CT shows a large cyst in the upper abdominal area. (b) EUS shows the cyst wall was 3 mm. The wall was not adhered to the gastric wall, as relative movement was observed. (c) After the needle puncture, cyst (red arrow) fluid will leak into the omental bursa. After cystotome dilation and stent placement, fluid leak (green arrow) begins to increase. (d) A large collection of fluid, measuring 3 cm, is seen below the cyst. (e) Transmural approach by a cystotome. (f) Intraperitoneal drainage by a 7 Fr nasobiliary catheter. (g) Drainage catheters seen on X-ray. (h) Pancreatic pseudocyst size is diminished, as confirmed by CT.